BackgroundPeople living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored rTMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke.MethodsEight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS.ResultsCompared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias.ConclusioniTBS could potentially offer a therapeutic option for smoking cessation in PLWHA.

AbstractBackgroundPeople living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined transcranial magnetic stimulation (TMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored TMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke.MethodsEight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS.ResultsCompared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias.ConclusioniTBS could potentially offer a therapeutic option for smoking cessation in PLWHA.

Background. People living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined transcranial magnetic stimulation (TMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored TMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke. Methods. Eight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS. Results. Compared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias. Conclusion. iTBS could potentially offer a therapeutic option for smoking cessation in PLWHA. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT04936594 ### Funding Statement This work was supported by the National Institutes of Health (grant numbers AA026255, TR001997, CA225419, MH129832, CX00293, MH111977) and University of Kentucky College of Medicine. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of University of Kentucky gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Background: Cigarette use is a leading cause of mortality among people living with HIV/AIDS (PLWHA) and currently approved smoking cessation strategies have modest efficacy. Brain stimulation could be a viable option to augment current smoking cessation strategies. There is little work determining the effects of theta burst stimulation (TBS) on predictors of relapse (e.g., craving and bias) and brain connectivity. Cigarette-cue attentional bias (AB) is a robust predictor of cigarette relapse. The present study examined the effects of one TBS session on cigarette craving, cigarette-cue AB, and functional connectivity in PLWHA. Methods: In an ongoing trial, eight cigarette using PLWHA were recruited and given one session of TBS (1800 pulses delivered at 120 % resting motor threshold). This was delivered to left dorsolateral prefrontal cortex (DLPFC) using MNI coordinates for BA 46 and T1 structural scan targeting via neuronavigation. Craving was measured via the Tobacco Craving Questionnaire (TCQ- SF) before and after the TBS session. Cigarette-cue AB was measured via the eye-tracking before and after the session. In addition, resting state functional connectivity brain scans were obtained pre- and post-session for all participants and processed using conn toolbox v20b. Results: Cigarette-using PLWHA smokers who received TBS showed a decrease in cigarette craving (t7 = 3.02, p = 0.019, d = 1.03) and cigarette-cue attentional bias (t7 = 2.65, p = 0.033, d = 0.89) after TBS, compared to before TBS. Participants who received TBS decreased functional connectivity from left DLPFC to voxels encompassing right and left superior frontal gyri, right and left paracingulate gyri, anterior division of cingulate gyrus, right and left middle frontal gyri (T=6.71, p-FDR=0.0003) after TBS compared to before TBS. Conclusion: These findings suggest TBS could be a promising adjunct to current smoking cessation strategies and AB could be a plausible biomarker to assess response. Keywords: TMS, attentional bias, smokers, HIV

Introduction Patients with cystic fibrosis (CF) have a high prevalence of comorbid anxiety and depressive symptoms, ranging from 8-29% in children and adolescents and 13-33% among adults. There is also a correlation between their physical symptoms and quality of life. A fixed-dose triple combination tablet of the cystic fibrosis transmembrane conductance regulator (CFTR) correctors elexacaftor and tezacaftor, along with the CFTR potentiator ivacaftor (hereafter referred to as TrikaftaTM) has been developed to treat patients with at least one F5508del mutation. No psychiatric or sleep-related adverse events have been reported with this combination until now. Case Report Here we present a case of a female patient who experienced worsening depression, anxiety, and worsening sleep paralysis with hypnopompic hallucinations following initiation of Trikafta therapy for CF, and consequent improvement of psychiatric symptoms following discontinuation and decreased dosing. Discussion In a previous case series, worsening of anxiety and depressive symptoms has been reported with lumacaftor/ivacaftor. Extrapolating from animal studies investigating ivacaftor’s effects on serotonin receptors, we would expect potential improvement of anxiety and depressive symptoms with Trikafta. However, this was not the case and ivacaftor’s effects on 5-HT2A receptors and/or her worsening depression could have played a role in exacerbating our patient’s sleep paralysis. As our patient’s psychiatric symptoms improved with discontinuation of Trikafta and worsened again with re-initiation of Trikafta, we advocate appropriate screening for psychopathology in patients with CF before initiating Trikafta.

BACKGROUND AND OBJECTIVES:Forty-nine out of 50 states have implemented Prescription Drug Monitoring Programs (PDMPs) to monitor controlled substance (CS) prescribing. PDMPs change health care provider behavior, but few studies have examined changes in CS prescription by health care provider type.METHODS:Aggregated yearly data, including number of CS prescriptions, doses, and doses per prescription by health care provider type (physician, advanced practice registered nurse [APRN], and dentist) for each year from 2011 to 2017 was provided by the state PDMP, Kentucky All Schedule Prescription Electronic Reporting System (KASPER). In aggregate, this data set included 64,578,307 total prescriptions and 3,982,130,994 total doses of Schedule II-V medications.RESULTS:Physicians and dentists showed a trend of decreasing prescriptions and doses for Schedule II opioids from 2012 to 2017 (27-32% reduction in 2017 compared to 2011). APRNs showed a substantive increase in the number of doses and prescriptions (121-204% increase in 2017 compared to 2011), with increases remaining when controlling for number of providers. Physicians increased doses and prescriptions of Schedule II stimulants (37% increase for both doses and prescriptions), but by a smaller magnitude than APRN increases in stimulants (334-360% increase). Dentists showed decreases in Schedule II stimulants prescribed (69-80% reduction). Similar trends, but more modest in magnitude, were observed for Schedule III-IV.DISCUSSION AND CONCLUSIONS:Although monitoring and continuing education requirements are similar across all providers in Kentucky, differences in prescription trends for Schedule II opioids and stimulants were noted for physicians, APRNs, and dentists.SCIENTIFIC SIGNIFICANCE:Changes in prescribing following introduction of mandatory use of KASPER markedly differed based on provider type, with increases observed for APRNs compared with physicians and dentists. These findings advance prior research by providing a detailed examination of prescribing trends by provider type subsequent to a PDMPs mandatory use law. (Am J Addict 2019;00:00-00).

Purpose: Network analysis has become increasingly popular in epidemiologic research, but the accuracy of data key to constructing risk networks is largely unknown. Using network data from people who use drugs (PWUDs), the study examined how accurately PWUD reported their network members' (i.e., alters') names and ages.Methods: Data were collected from 2008 to 2010 from 503 PWUD residing in rural Appalachia. Network ties (n = 897) involved recent (past 6 months) sex, drug cousage, and/or social support. Participants provided alters' names, ages, and relationship-level characteristics; these data were cross-referenced to that of other participants to identify participant-participant relationships and to determine the accuracy of reported ages (years) and names (binary).Results: Participants gave alters' exact names and ages within two years in 75% and 79% of relationships, respectively. Accurate name was more common in relationships that were reciprocally reported and those involving social support and male alters. Age was more accurate in reciprocal ties and those characterized by kinship, sexual partnership, recruitment referral, and financial support, and less accurate for ties with older alters.Conclusions: Most participants reported alters' characteristics accurately, and name accuracy was not significantly different in relationships involving drug-related and/or sexual behavior compared to those not involving these behaviors. (C) 2016 Elsevier Inc. All rights reserved.